Ovarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age.
Fourcadier et al BMC Cancer (2015) 15:937 DOI 10.1186/s12885-015-1947-9 RESEARCH ARTICLE Open Access Under-treatment of elderly patients with ovarian cancer: a population based study Elisabeth Fourcadier1, Brigitte Trétarre1, Claudine Gras-Aygon1, Fiona Ecarnot2, Jean-Pierre Daurès1 and Faïza Bessaoud1* Abstract Background: Ovarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly The primary objective of this study was to compare treatment of ovarian cancer according to age Methods: All patients with invasive cancer (n = 1151) diagnosed between 1997 and 2011 in the Herault Department of southern France were included Demographic data (age, area of residence), cancer characteristics (stage, histology, grade) and treatment modality (type, period and location of treatment) were analysed Univariate and multivariate logistic regression was used to compare treatment by age Results: Ovarian cancer was less treated in elderly compared to younger patients, regardless of the type of treatment This difference was more pronounced for chemotherapy, and was maximal for surgery followed by chemotherapy (odds ratio (OR) for surgery for patients aged >70 vs those aged 70 vs 70 vs 70 years old Other variables considered were demographic data and cancer characteristics (stage, grade, histology) We recorded the area of residence (urban or rural) Tumour stage was recorded and classified into four groups according to the TNM classification system and International Federation of Gynecology and Obstetrics (FiGO) staging system (UICC 6th edition) In our study, tumor histology was classified according the World Health Organization (WHO) classification and grouped into epithelial type; other; or “unknown histology”, when there was no microscopic confirmation or no histological testing The tumor grade was coded in three categories: welldifferentiated (grade 1), moderately differentiated (grade 2), and poorly differentiated (grade 3) or unknown The healthcare establishment where the first treatment took place was categorized into: private for-profit clinics, public university teaching center (Public Univ.), public nonacademic (Public non Univ.) and Unknown or Outside the Hérault department (Unknown) The study period was divided into three classes: before (≤2002), during (2003–2007) and after (≥2008) the Fourcadier et al BMC Cancer (2015) 15:937 national cancer plan The national cancer plan mobilizes a national foundation for the organization healthcare and prevention, and provides support for research in the field of cancer This plan includes the creation of an oncogeriatrics task force responsible for the promotion and coordination of projects in the field of epidemiology, prevention and adaptation of treatments and clinical trials in the elderly population [16] The variables recorded for survival analysis included the date of diagnosis, the date of last contact and vital status (alive/deceased) Vital status was obtained from National Institute of Statistics and Economic Studies (INSEE) and the National Directory for the Identification of Individuals (RNIPP) The descriptive and comparative part of this study covers the period 1997–2011 and the survival analysis covers the period 1997–2010, with follow-up ending on 30/06/2013 Our descriptive and comparative analysis focuses on 1151 cases and the survival analysis on 1056 cases (692 deaths and 364 censored) Page of 10 performed using the “relsurv” package specific to relative survival analysis Results Among 1151 women diagnosed with invasive ovarian cancer, 38.9 % were elderly (≥70 years old) The average age was 64.7 years, median age was 66 years Table shows the characteristics of ovarian cancer according to age at diagnosis Compared to younger women, elderly patients more frequently had their cancer diagnosed at a more advanced stage (p